Sirs_and_Sepsis

Systemic Inflammatory Response Syndrome Sepsis Densie Cox Introduction Systemic Inflammatory Responses Syndrome is a serious condition where there is inflammation through out the whole body. It may be caused by a severe bacterial infection, sepsis, trauma or pancreatitis. Sepsis is an infection of the bloodstream and is the body's response to an infection. The infection tends to spread quickly and is difficult to recognize. When an infection isn't contained at its' source, the infection leaks into the bloodstream and causes sepsis. This is associated with inflammation and maldistribution of blood flow. When bacteria enters the bloodstream, it releases a toxic substance. The body's immune response is activated and releases proinflammatory mediators into the body's system. These mediators consist of prostaglandins and cytokines, including tumor necrosis factor(TNF) and interleukines. From the bloodstream WBC's respond with cytokines and cause vasodilation, increased capillary permeability and increased coagulation. In a septic person, too much of the cytokines are stimulated causing an exagerrated response. ● Cytokine induced systemic vasodilation and hypovolaemia are responsible for renal hyperfusion. Muscular System ● Tissue injury occurs during inflammation. ● Impaired fibrinolysis is due to decrease in clot breakdown. ● Tissue injury is related to fibrin clots which leads to microthrombi. ● Microthrombi causes hypoperfusion of tissues leading to tissue necrosis. ● Tissue necrosis leads to muscular degeneration. emedicine.medscape.com Treatment for patients with Sepsis Initial medical care should be focused on the cause of SIRS and Sepsis. A broad spectrum antiobiotic should be started immediately to prevent further increase in infection. Failure to insigate appropriate antibiotic therapy increases mortality. Blood cultures should be obtained to determine the bacterial cause. Treatment pertaining to systems addressed should include oxygen via nasal canula to provide supplemental oxygen and treat respiratory alkalosis. Mechanical ventilation may be neccessary to support failing respiratory function and to reduce the amount of work in breathing dueto impaired lung activity. All patients should have I V access either with 2 large- bore intravenous lines or central venous access. Cardiac treatment should include support with fluids to treat hypotension and vassopressive angents if needed. Patients should have a foley catheter inserted to record hourly measurments for follow up on urine output. It is important to maintain nutrition to help withthe healing of the muscular system and to prevent gut mucosal atrophy. Systems Cardiac System. ● Vasodilation is the body's way of increasing blood flow to an affected area. ● Increased blood volume results in hypotension. ● Increased capillary permeability results in hypotension. ● Increased cardiac output results in tachycardia and increased stroke volume. ● Increased capillary permeability allows fluid to leak out of the bloodstream resulting in edema. Respiratory System. ● Manifested by tachypnea, hypoxaemia and respiratory alkalosis. ● Severe response will cause acute lung injury ● Acute respiratory disease syndrome results from lung injury. Renal System ● Auto regulation is disturbed. Objectives A focused physical examination is necessary to identify signs of Sepsis and SIRS. Sepsis usually begins with SIRS, but it is possible to have SIRS without Sepsis. SIRS is diagnosed when 2 or more of the following criteria are met. ● Fever of more than 100.4 or less than 96.8. ● Heart rate of greater than 90 beats per minute. ● Respiratory rate of greater than 20 breathes per minute or PACO2 level less than 32mm/hg. ● Abnormal white blood count greater than 12,000/ul or less than 4,000/ul or greater than 15% sats. Sepsis is present when a patient has SIRS and a documented infection. The cause of infection can be bacterial, viral or caused by fungus. Conclusions A role of the nurse is to be a patient advocate and by being in a close relation to the patient, a nurse is able to detect subtle changes in a patient's illness at an early onset. Sepsis and SIRS cover a wide range of conditions and are considered complex in their pathophysiology. Knowledge of the signs and symptoms of SIRS and Sepsis is important for early recognition. Once the nurse can diagnose sepsis, an early and aggressive treatment can be started. With the early recognition and treatment, mortality rates associated with sepsis are greatly reduced. References Dellacroce, Heather, RN, M SN, APN-C, CCRN.,(July2009) Survivng Sepsis: THE ROLE OF THE NURSE. RN Your Career, Your Life, 2009, 16-21. Patterson, R.L., Webster, N.R. ( 2000,June) Sepsis and systemic inflammatory response syndrome. Journal vol 45. Retrieved April 28, 2010 from the World Wide Web: http:// www.rcsed.ac.uk. Burdette, S.D.,MD,parilo, M.A.,MD, Kaplan, L.J.,MD,Bailey,H.,MD., (2010,April) Systemic Inflammatory Response Syndrome, EMedicine. Retrieved April 28,2010 from the World Wide Web: http:// emedicine.medscape.com/article/168943.